Provider Demographics
NPI:1720223167
Name:MORRIS, A MAUREEN (LMT)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:MAUREEN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W DR MLK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6529
Mailing Address - Country:US
Mailing Address - Phone:813-873-9229
Mailing Address - Fax:813-873-9228
Practice Address - Street 1:1931 W DR MLK BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6529
Practice Address - Country:US
Practice Address - Phone:813-873-9229
Practice Address - Fax:813-873-9228
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA28992OtherAL614 - GROUP MEDICARE PTAN